April Blong, DVM, DACVECC, discusses what to look for and how to triage an animal in this condition.

Managing a patient in shock

What signs of shock should a veterinary team identify in emergency cases? And what triage should be done to care for a patient in shock?

April Blong, DVM, DACVECC, discussed shock and how to manage as part of a series of continuing education lectures she presented at the 2025 Fetch Kansas City Conference in Kansas City, Missouri. In an interview with 

, she discussed common signs of shock that patients exhibit when seen in veterinary emergency facilities and how medical care providers can improve outcomes with early interventions.

Common causes of blunt force trauma in pets

Blong is an associate clinical professor at the Iowa State University Lloyd Veterinary Medical Center in Ames and the medical director at Iowa Veterinary Specialties in Des Moines. A graduate of Iowa State University’s College of Veterinary Medicine, she completed a residency in emergency and critical care at Cornell University in Ithaca, New York.

The following is a transcript of this video:

: Most commonly, we see things like elevated heart rate, weak pulses, pale gums. And I think a lot of people recognize the patient that comes in collapse, the gums are white. You can't feel the pulses. That patient’s in trouble. I think where the learning curve sort of happens is that that's the end stage of shock. We want to catch these patients when they're just mildly tachycardic. Their respiratory is just a little elevated. Their pulses are okay, but they're not great. They're CRTs [are] right at that 2-second mark. Those are those kiddos and those compensated shock where we really want to intervene, because those are the ones we know we can always fix. If we intervene during the compensated stage of shock, they haven't accumulated organ injury. They haven't accumulated all the damage from shock, and that patient, at least from a shock standpoint, is always reversible. And so I think it's really educating people on to catch those signs before they get to where they're all the way down the road: pale gums, passed out, unresponsive. That's the key.

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Videos

April Blong, DVM, DACVECC, discusses what to look for and how to triage an animal in this condition, in a dvm360 interview.

Identifying signs and managing triage for a patient in shock

Melissa Evans, CVT, LVT, VTS (ECC), walks technicians through stabilizing blocked cats. 

Technician steps for stabilizing and preparing cats for unblocking

Melissa Evans, CVT, LVT, VTS (ECC), owner and founder of Melissa Evans, VTS (ECC) Veterinary Nurse Consulting, goes through the steps veterinary technicians should take for stabilizing and preparing a blocked cat for the unblocking process. She highlights key considerations for patient safety, monitoring, and supportive care during this stage.

Below is a transcript of the video, which has been lightly edited for improved clarity.

 Once an animal presents [and] we've decided that they are blocked by getting a history, feeling their bladder—usually it will be hard, we'll be unable to express it; maybe we'll put an ultrasound probe on there to see how large it is. Once we've decided that they are probably blocked, we're going to go ahead and place [a] catheter and get some blood work for sure.

Most of these patients are usually hyperkalemic, so they have an increased potassium and that messes up the heart conductivity, so it causes the heart to not be as reactive as it should be. We'll see bradycardia. For cats, a normal heart rate is around 180 to 200 [beats per minute (bpm)] but with cats who have this hyperkalemia, we'll see it as low is 100 [bpm], sometimes lower than that, so pretty low.

So, we're going to go ahead, and the doctor will probably ask that we give some calcium gluconate, which antagonizes the effects of potassium on the heart and makes it start to work again. It's sort of a heart protectant.

And then we'll also possibly give insulin [intravenously], which forces potassium intracellularly from the extracellular level. And with that, we're probably going to give dextrose just so that we don't make [patients] hypoglycemic. But also, dextrose has another benefit in that it tells the body to go ahead and make its own insulin, so that we get a little bit of extra insulin going in there.

And then we'll start them on fluids, get them hooked up to all the monitoring, and sedate them—and hopefully get them unblocked as quickly as possible.

The Purina Institute recently released a new handbook on canine and feline nutrition. According to the institute, the book, which veterinary professionals can access online for free, is a product-agnostic resource that offers scientific and practical information on the nutritional management for healthy cats and dogs.

Purina Institute Handbook of Canine and Feline Well-Pet Nutrition

, contains contributions from 54 experts across 20 countries and builds on the 

Purina Institute Handbook of Canine and Feline Clinical Nutrition

, released by the Purina Institute in 2023. According to Purina, the latest e-book addresses questions and challenges veterinary professionals often face during discussions with clients about nutrition.

Purina Institute Handbook of Canine and Feline Well-Pet Nutrition. (Image courtesy of Purina Institute)

“The [handbook] is a one-of-a-kind resource with a global perspective containing unbiased, science-based information, and it’s designed with the busy veterinary professional in mind, containing tips and tools to help with veterinary health care teams having those difficult nutrition conversations with clients,” Jason Gagné, DVM, DACVIM (Nutrition), director of external relations at the Purina Institute, said during a virtual panel discussion on the handbook’s launch.

"Nutritional science has evolved significantly, and there are many facets to consider in a well-pet diet, not just from the pet's perspective, such as life stage, activity level, and body condition, but also the owner's perspective—

 lifestyle, budget, and preferences," Natalia Wagemans, global head of the Purina Institute, said in an organizational news release.

 "This resource simplifies the process of making informed recommendations and can be a vital tool for veterinary professionals to both facilitate nutrition conversations with their clients and provide informed responses to questions."

Specifically, the handbook contains information on the following

Specialized nutrition for different life stages

Communication techniques for discussing nutrition with pet owners

According to Catherine Lenox, DVM, DACVIM (Nutrition), one of the coauthors and editors of the book, a 2023 survey found that 96% of pet owners consider veterinarians their most trusted source for nutrition advice.

 However, only 22% of veterinary professionals reported regularly having proactive nutrition discussions with clients during most visits.

 The same survey also found that 78% of pet owners view receiving nutrition advice as an “important” or “extremely important” factor in their satisfaction with their veterinary clinic.

“Overall, the data show that we, as veterinarians, may not be having nutrition conversations as often as ideal, and when I say 'often as ideal,' that refers to both the pet and pet health, but also what the owner desires,” Lenox said.

Coauthor and coeditor of the e-book, Jonathan Stockman, DVM, DACVIM (Nutrition), believes the disparity between pet owners’ wants and the actual frequency of nutrition discussions is due to short appointment times and a lack of education surrounding nutrition in veterinary school.

“Many times, the appointments are pretty short. You don’t really have a lot of time to refer to any resources that you want to look at before you have these conversations with owners,” Stockman said during the panel discussion.

“Also, a global issue in veterinary education...is sometimes nutrition is not emphasized enough, so a lot of veterinarians graduate without having the confidence that they need [for] having these conversations, especially when there are opposing opinions regarding nutrition.”

He added that having the handbook as a reliable, credible resource is valuable for veterinarians. “It’s...quick to refer to and [provides] us [with] additional information that you need for these discussions in the clinic,” he said.

“Each chapter is designed to be concise and accessible, featuring key takeaways, communication tips, and visual aids that serve as quick references during busy clinic days,” Purina wrote in its launch announcement.

 “This resource not only enhances the veterinary team's ability to provide informed dietary recommendations but also fosters a collaborative approach to pet health that includes the entire veterinary staff.”

Unlocking the power of nutrition: Purina Institute releases new well-pet nutrition handbook for veterinary professionals. News release. Nestle Purina PetCare. August 28, 2025. Accessed September 8, 2025. https://www.prnewswire.co.uk/news-releases/unlocking-the-power-of-nutrition-purina-institute-releases-new-well-pet-nutrition-handbook-for-veterinary-professionals-302540777.html?tc=eml_cleartime

Purina Institute YouTube page. Accessed September 8, 2025. https://www.youtube.com/watch?v=F8zUSRY0NHA

Articles

In a recent panel discussion on the handbook's launch, Jonathan Stockman, DVM, DACVIM (Nutrition), coauthor and editor of the book, noted a gap in nutrition education among veterinary professionals.

Free pet nutrition e-book released for veterinary professionals

On July 17, 2025, the FDA approved fluralaner oral solution (Exzolt; MSD Animal Health) for the treatment and control of 

, also known as northern fowl mites, in laying hens and replacement chickens. The parasiticide is the first FDA-approved therapy for the treatment and control of northern fowl mites in poultry and is the first oral solution of its kind.

According to MSD Animal Health, the product is more than 99% effective.

The product works by systemically treating birds by adding it to their drinking water. Specifically, veterinarians administer the solution to laying hens and replacement chickens via drinking water through 2 single doses of fluralaner 0.5 mg/kg body weight (0.227 mg/lb), which is equivalent to fluralaner oral solution 0.05 mL/kg body weight (0.023 mL/lb). The doses should be administered 7 days apart. Each dose should be consumed over a period of 6 to 24 hours.

The parasiticide is only available through prescription from a licensed veterinarian. “Professional expertise is required to monitor the safe and effective use of this product,” the FDA wrote in its announcement.

The FDA noted that care should be taken when handling the product. When administering fluralaner oral solution, people should wear protective gloves and avoid exposing their skin and eyes to the product. Accidental exposure to the skin or eyes may cause irritation.

In a release announcing the product’s approval, the FDA said consuming poultry treated with fluralaner oral solution is not considered a public health risk, provided the product is used according to the label. “In addition to establishing that fluralaner is safe and effective in laying hens and replacement chickens, the FDA determined that residues in edible tissues or eggs from birds treated with Exzolt will not represent a public health concern when the product is used according to the label,” the FDA wrote.

Two dose confirmation studies and 2 field studies demonstrated the effectiveness of fluralaner oral solution. Its target animal safety, meanwhile, was evaluated in 4 studies. No clinically significant adverse effects were observed.

At the time, the product is not at risk of developing antimicrobial resistance.

FDA approves first oral product for treatment and control of northern fowl mites in laying hens and replacement chickens. News release. FDA. July 17, 2025. Accessed September 5, 2025. https://www.fda.gov/animal-veterinary/cvm-updates/fda-approves-first-oral-product-treatment-and-control-northern-fowl-mites-laying-hens-and

Exzolt Fluralaner. MSD Animal Health. Accessed September 5, 2025. https://www.exzolt.com/

Freedom of information summary. FDA. July 17, 2025. Accessed September 5, 2025. https://animaldrugsatfda.fda.gov/adafda/app/search/public/document/downloadFoi/17210

The parasiticide also treats Dermanyssus gallinae, also known as red mites.

FDA approves first oral solution for the treatment and control of northern fowl mites in poultry

Chylothorax is the accumulation of lymphatic fluid (also known as chyle) within the thoracic cavity.

 Because of the rib cage's rigid confines, fluid accumulation within the thoracic cavity is not well tolerated and results in respiratory signs, such as increased respiratory rate and effort, after reaching a critical volume. This volume depends on the rate at which it accumulates, the individual dog’s size, respiratory adherence, and overall respiratory function.

While fluid gradually builds up in the thoracic cavity over time, dogs are often presented on an emergency basis, as the fluid hits the critical volume that results in a respiratory crisis. Once the respiratory system is affected, fluid removal via thoracocentesis is required to improve respiratory function.

To make a chylothorax diagnosis, a diagnostic thoracocentesis is required. This is often performed in conjunction with a therapeutic thoracocentesis to improve the dog’s respiratory function. Thoracic fluid triglycerides will be increased relative to the dog’s serum levels, whereas fluid cholesterol will be reduced relative to the dog’s serum levels.

 It is important that the pleural fluid values are compared to a concurrently collected serum sample and not historical data. Cytological evaluation is important to rule out other sources of pleural effusion, but it can have various cell types present with a chylothorax diagnosis.

Canine chylothorax is most commonly considered to be idiopathic in nature, but it can also be caused by any disease process that results in a disruption of normal lymphatic flow.

 Primary causes resulting in secondary chylothorax have included cranial mediastinal mass effects, primary cardiac disease, pericardial effusion, trauma, and lung lobe torsions.

 When investigating chylothorax, it is important that all possible causes are ruled out before making the presumptive diagnosis of idiopathic chylothorax, as treatments will differ based on the primary cause. When chylothorax is the secondary result of another disease process, the primary disease process must first be addressed before considering direct interventions for treating the chylothorax itself.

Diagnostic evaluation may include thoracic and abdominal imaging to evaluate intrathoracic and intra-abdominal structures, echocardiography to evaluate for primary cardiac disease and pericardial effusion, and a CT lymphangiogram (CTLA) to rule out compressive lesions of the lymphatic and venous systems.

 If advanced imaging is not immediately available, thoracic and abdominal radiography and/or ultrasonography may be used to rule out space-occupying lesions, with CT imaging being reserved for dogs more likely to have idiopathic chylothorax and a desire for surgical interventions.

Following the diagnosis of idiopathic canine chylothorax, treatment options may include medical or surgical therapies.

Medical management may include the following

Therapeutic thoracocenteses are used as needed to remove the buildup of chylous effusion within the thorax to improve clinical respiratory signs. Overall success has been reported in only 26% of animals with idiopathic chylothorax, likely because of the progressive inflammatory changes within the thoracic cavity resulting in difficulty with complete pleural evacuation over time, as well as the development of pleural fibrosis.

Low-fat diets have been used to reduce the overall production of chyle, thus reducing the flow of chyle through the lymphatic system, which may reduce the volume of chylous effusion buildup and allow time for defects in the thoracic duct to heal. Evidence in dogs suggests that the lipid content of chyle can be reduced with this treatment, but the flow through the thoracic duct is not directly reduced.

Octreotide, a somatostatin analog, has been used to reduce the flow of chyle through the thoracic duct. This has been used with success in human patients who have chylous effusion secondary to trauma to the thoracic duct but has been less successful in dogs with idiopathic chylothorax.

Surgical interventions may include the following

Thoracic duct ligation is ideally planned based on CTLA, as this imaging can best identify the anatomic variations of an individual thoracic duct.

 The duct can be accessed through open or minimally invasive approaches and is ligated with suture or hemoclips as far caudally in the thoracic cavity as possible to ensure all contributing branches are obstructed. The forward flow of chyle is prevented in the short term while the body develops new lymphaticovenous connections to restore chyle flow.

 Intraoperative use of near-infrared fluorescence (NIRF) imaging can be used to confirm complete occlusion of the thoracic duct.

Subtotal pericardiectomy can also be performed via open or minimally invasive approaches. Removal of the pericardium is aimed at reducing the systemic venous pressure as chyle is being returned to the heart via the cranial vena cava. Increased pressure from primary cardiac disease and/or a constrictive pericardium can result in back pressures within the vena cava and lymphatic extravasation into the thoracic cavity. Determining whether constrictive pericarditis is present can be challenging and invasive;

 thus, combining a subtotal pericardiectomy with a thoracic duct ligation has been reported without a definitive diagnosis of constrictive pericarditis.

Cisterna chyli ablation can be performed through an open or minimally invasive approach. This procedure aims to reduce the forward flow of lymphatic fluid into the thoracic duct by opening the cisterna chyli and allowing lymphatic fluid to drain into the abdominal cavity.

 When combined with thoracic duct ligation, this can reduce the pressure of any forward flow of chyle on the thoracic duct ligation and allow time for the new lymphaticovenous connections to be developed. These new connections may be made within the abdominal cavity, reducing the risk of further chyle leakage within the thoracic cavity.

PleuralPort placement is a long-term solution for thoracic drainage of chylous (or other) effusion.

 A fenestrated catheter is surgically placed within a hemithorax and is connected to a drainage port that is placed within the subcutaneous space on the dorsolateral aspect of the ipsilateral hemithorax. The port can be palpated externally and accessed percutaneously with a Huber needle to intermittently drain the thoracic cavity without requiring repeated puncturing of the pleura for thoracocentesis.

 Unilateral or bilateral PleuralPorts can be placed based on the volume of effusion and accessibility of the fluid. A PleuralPort is often considered when surgical management has failed, but it can also be considered in place of surgical intervention.

Many combinations of surgical procedures have been reported.

 The most reported combinations include thoracic duct ligation with concurrent subtotal pericardiectomy and thoracic duct ligation with concurrent cisterna chyli ablation.

 A combination of thoracic duct ligation, subtotal pericardiectomy, and cisterna chyli ablation has also been reported in veterinary literature.

Medical management has a limited success rate for idiopathic chylothorax overall.

 Surgical interventions have a variety of reported success rates, with marked improvement in success being noted with the more recent use of preoperative (CTLA) and intraoperative (NIRF) imaging techniques.

 With these improved imaging techniques, the previously reported need to combine surgical techniques has recently been challenged.

 Although there are many approaches to surgically managing idiopathic canine chylothorax, the specific approach will be made based on the diagnostic information collected from an individual dog, along with the skill set, knowledge, and preference of the surgical care team.

Katie Hoddinott, DVM, DVSc, BSc, DACVS-SA

, is a native of Nova Scotia, Canada. She graduated with her DVM from the Atlantic Veterinary College, University of Prince Edward Island, in 2012. She then completed 2 internships and a surgery residency at the Ontario Veterinary College, University of Guelph. She became a diplomat of the American College of Veterinary Surgeons – Small Animal in 2019. Hoddinott is currently working at the Atlantic Veterinary College as an assistant professor in small-animal surgery, where she enjoys teaching undergraduate veterinary students, interns, and residents. Her professional interests lie mainly in surgical oncology and minimally invasive soft tissue surgery. Her current research focuses on advances in clinical teaching for surgery residents and surgical site infections.

Hawker W, Singh A. Advances in the treatment of chylothorax. 

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Mayhew PD, Steffey MA, Fransson BA, et al. Long-term outcome of video-assisted thoracoscopic thoracic duct ligation and pericardectomy in dogs with chylothorax: a multi-institutional study of 39 cases. 

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Lee N, Won S, Choi M, et al. CT thoracic duct lymphography in cats by popliteal lymph node iohexol injection. 

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Lin LS, Chiu HC, Nishimura R, Fujiwara R, Chung CS. Computed tomographic lymphangiography via intra-metatarsal pad injection is feasible in dogs with chylothorax. 

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Singh A, Brisson B, Nykamp S. Idiopathic chylothorax in dogs and cats: nonsurgical and surgical management. 

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Steffey MA, Mayhew PD. Use of direct near-infrared fluorescent lymphography for thoracoscopic thoracic duct identification in 15 dogs with chylothorax. 

 2018;47(2):267-276. doi:10.1111/vsu.12740

Mayhew PD, Balsa IM, Stern JA, et al. Resolution, recurrence, and chyle redistribution after thoracic duct ligation with or without pericardiectomy in dogs with naturally occurring idiopathic chylothorax. 

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Adams TE, Marvel SJ, Monnet E. Constrictive physiology is not present in all dogs with idiopathic chylothorax. 

2024;262(10):1354-1362. doi:10.2460/javma.24.02.0124

Fossum TW, Mertens MM, Miller MW, et al. Thoracic duct ligation and pericardectomy for treatment of idiopathic chylothorax. 

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McAnulty JF. Prospective comparison of cisterna chyli ablation to pericardectomy for treatment of spontaneously occurring idiopathic chylothorax in the dog. 

 2011;40(8):926-934. doi:10.1111/j.1532-950X.2011.00902.x

Allman DA, Radlinsky MG, Ralph AG, Rawlings CA. Thoracoscopic thoracic duct ligation and thoracoscopic pericardectomy for treatment of chylothorax in dogs. 

 2010;39(1):21-27. doi:10.1111/j.1532-950X.2009.00623.x

Bianchi A, Collivignarelli F, Paolini A, et al. Thoracoscopic assisted PleuralPort

 application in seven dogs affected by chronic pleural effusion. 

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Tirillini F, Montinaro V, Cipolla E, Cinti F. Management of chronic pleural effusion in dogs and cats using the PleuralPort device: complications and outcome of 30 cases (2005-2024). 

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Ishigaki K, Nagumo T, Sakurai N, Asano K. Triple-combination surgery with thoracic duct ligation, partial pericardiectomy, and cisterna chyli ablation for treatment of canine idiopathic chylothorax. 

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There are many methods for surgically managing idiopathic canine chylothorax, but diagnostic information collected from an individual dog will guide the specific approach.

Managing canine chylothorax

More than 100 dogs and puppies were rescued from an alleged large-scale neglect case at a breeder’s home in Harford County, Maryland, on August 27, 2025.

According to a news report by Humane World for Animals, a global animal welfare organization, local authorities found the animals living in unsanitary, cramped conditions, with some being emaciated and in need of veterinary care.

Around 7 AM on August 27, the Harford County Sheriff’s Office executed a search and seizure warrant at the property, with Humane World for Animals assisting with the rescue. The welfare organization reported strong ammonia and fecal odors throughout the residence. Rescuers found some dogs roaming throughout the residence, whereas other dogs were confined to stacked wire-bottom cages without visible access to food or water. Several dogs were kept in 1-ft by 1-ft, 6-in cages in groups of 2 to 3.

Images courtesy of Meredith Lee/Humane World for Animals.

"It's an overwhelming, heartbreaking scene. You couldn't walk a few feet without stepping around dogs or slipping in their waste," Stacy Volodin, Maryland state director for Humane World for Animals, said in the report.

 "We are grateful to the Harford County Sheriff's Office for their work to investigate and intervene in this situation."

Authorities also found a mother dog in a whelping box nursing 3-week-old puppies near a recently deceased puppy. Some of the neonates showed signs of urine scalding. According to the report, veterinarians observed several dogs with dental abscesses, eye discharge, and skin infections. Many dogs were also underweight, with some emaciated and severely matted.

"Our Animal Control Unit plays a vital role in protecting the health and safety of both animals and our community," Jeffrey Gahler, Harford County sheriff, said.

 "Through strong partnerships with local organizations like Humane World for Animals and our local humane society, as well as engaged citizens, we're able to respond compassionately to situations where animals are at risk. Together, we can work to see that every animal in Harford County is treated with dignity and care."

According to Humane World for Animals, the dogs came from a Havanese and Biewer terrier breeding operation that has historically advertised breeding parents with American Kennel Club (AKC) titles. Humane World for Animals said this case underscores that photos, AKC pedigrees, and assurances from pet stores or online platforms cannot guarantee that a puppy received proper care.

Humane World for Animals assists the Harford County Sheriff’s Office with the dogs' rescue.

Following their rescue, the animals were moved to an undisclosed location where responders and volunteers with Humane World for Animals are providing veterinary care. According to the organization, RedRover Responders volunteers are also helping with the animals’ daily care.

The case is not the first dog rescue in Harford County this year. Earlier this summer, local officials rescued 44 bully-type breed dogs at a residence in the county.

Authorities initiated an animal cruelty investigation after receiving a report of inhumane conditions at a residence in the area on July 17, 2025. Six days later, the county’s sheriff’s office led a search warrant on the property.

Upon entry, animal control officers observed a lack of access to water, improper shelter, poor air quality, and insufficient space. According to a news release by the Harford County Sheriff’s Office, the property did not have enough ventilation and temperature controls in the areas where the dogs were being housed.

 Moreover, bedding in the kennels was also “extremely” soiled.

“Upon arrival, animal control officers observed multiple violations of Maryland Criminal Law [Title 10, Section 604] and Harford County Code [Section 64-18], pertaining to the mistreatment, abuse, or neglect of animals,” the sheriff’s office wrote in a news release.

The dogs have since been safely transported to a local shelter for evaluation and care, according to the sheriff’s office.

'An overwhelming, heartbreaking scene:' over 100 dogs and puppies rescued from alleged neglect at Havanese breeder's residence in Harford County, Maryland. News release. Humane World for Animals. August 27, 2025. Accessed September 4, 2025. https://www.humaneworld.org/en/news/harford-county-dog-rescue-havanese-breeder-neglect 

Animal cruelty investigation leads to a major dog rescue in Whiteford. Harford County Sheriff’s Office. News release. July 17, 2025. Accessed September 4, 2025. https://harfordsheriff.org/news/releases/animal-cruelty-investigation-leads-to-major-dog-rescue-in-whiteford/

Local officials in Harford County, Maryland, executed a search and seizure warrant, rescuing numerous dogs and puppies found in unsanitary conditions and in need of veterinary care.